ABSTRACT
Un varón de 61 años sin predisposición trombótica es sometido a trasplante bipulmonar como último tratamiento para su EPOC terminal sin soporte de ECMO. Tras el implante y la reperfusión de ambos pulmones, se realizó un examen ecocardiográfico transesofágico completo para comprobar principalmente las anastomosis de las venas pulmonares. En este estudio se identificó una gran masa móvil, hiperecogénica, densa y heterogénea en la aurícula izquierda, compatible con un trombo en tránsito desde la circulación venosa pulmonar. Este hallazgo fue comunicado al equipo quirúrgico inmediatamente para reabrir la anastomosis y retirar el coágulo antes de mayores consecuencias. No hubo manifestaciones clínicas cuando se despertó al paciente.(AU)
61-year-old man without any thrombotic predisposition was undergone double sequential lung transplantation due to terminal stage of COPD without extracorporeal membrane oxygenation (ECMO) support. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography exam was performed to check especially the pulmonary venous anastomosis. In this exam, a large heterogenous, dense, hyperechoic mobile mass was identified in the LA, which was compatible with a thrombus in transit from pulmonary veins circulation. This finding was communicated to the surgical team to reopen the anastomosis and remove the clot before further consequences. There were no clinical manifestations when the patient was awakened.(AU)
Subject(s)
Humans , Male , Middle Aged , Echocardiography, Transesophageal , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/injuries , Thrombosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Lung Transplantation , Anesthesiology , Inpatients , Physical Examination , TransplantsABSTRACT
A 61-year-old man with no predisposition to thrombosis underwent sequential double lung transplantation without extracorporeal membrane oxygenation (ECMO) support due to terminal stage COPD. After implantation and reperfusion of both lungs, a complete transoesophageal echocardiography study was performed to check the pulmonary venous anastomosis. The study showed a large, heterogeneous, dense, hyperechoic free-floating mass in the left atrium compatible with a clot in transit from the pulmonary circulation. The surgical team were notified of this finding so that they could reopen the anastomosis and remove the clot to prevent a major complication. There were no clinical manifestations when the patient was awakened.
ABSTRACT
Las complicaciones cardiorrespiratorias son las principales causas de morbimortalidad en las unidades de cuidados críticos (UCC). Las técnicas de imagen son una pieza fundamental tanto en el diagnóstico diferencial como en el tratamiento. En la última década la ecografía ha demostrado gran potencial para el diagnóstico a pie de cama de patología respiratoria, así como para la valoración hemodinámica de los pacientes críticos. La ecografía ha demostrado ser una guía útil para la identificación del tipo de shock, la estimación del gasto cardiaco, guiar la fluidoterapia y los fármacos vasoactivos, aportar seguridad en la realización de las técnicas percutáneas (toracocentesis, pericardiocentesis, evacuación de abscesos/hematomas), objetivar de forma dinámica y en tiempo real la atelectasia pulmonar y su respuesta a las maniobras de reclutamiento alveolar, y predecir el fracaso en el destete de la ventilación mecánica. Por su carácter dinámico, sencilla curva de aprendizaje y ausencia de radiación ionizante, se ha incorporado como una herramienta imprescindible en la práctica clínica diaria en las UCC. El objetivo de la presente revisión es ofrecer una visión global del papel de la ecografía y sus aplicaciones en el paciente crítico.(AU)
Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.(AU)
Subject(s)
Humans , Ultrasonography , Diagnosis , Monitoring, Physiologic , Intensive Care Units , Respiratory Tract Diseases/complications , Critical Care , Cardiopulmonary Resuscitation , Anesthesiology , SpainABSTRACT
Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.
Subject(s)
Critical Care , Critical Illness , Humans , Critical Care/methods , Ultrasonography/methods , Intensive Care Units , Respiration, ArtificialABSTRACT
La ecocardiografía transesofágica (ETE) es una herramienta fundamental en el intraoperatorio y postoperatorio de cirugía cardiaca con una gran difusión en los últimos años. El objetivo de este trabajo es conocer la situación actual de la ETE en el ámbito de la anestesiología en cirugía cardiaca en España a través de una encuesta nacional que explora la disponibilidad de equipos, indicación y utilización de dicha técnica, así como la formación y acreditación de los profesionales responsables. Los hallazgos muestran que en España la ETE intraoperatoria es parte integral de los procedimientos cardiovasculares hoy en día y en la mayor parte de los centros es realizada por anestesiólogos altamente involucrados en este tipo de cirugías. A pesar de la ausencia de formación estructurada en el currículum formativo de nuestra especialidad, los anestesiólogos adquieren las competencias mediante rotaciones específicas de corta duración y un alto porcentaje de ellos ha obtenido la acreditación oficial
Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation
Subject(s)
Humans , Monitoring, Intraoperative/methods , Cardiac Surgical Procedures , Health Care Surveys , Intraoperative Period , Echocardiography , SpainABSTRACT
Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.
ABSTRACT
La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions
Subject(s)
Humans , Echocardiography, Transesophageal/methods , Cardiovascular Surgical Procedures/methods , Monitoring, Intraoperative/methods , Hemodynamic Monitoring/methods , ConsensusABSTRACT
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
ABSTRACT
Introducción: La cirugía cardíaca se asocia a un uso significativo de hemoderivados. El objetivo de este estudio fue evaluar el efecto de la transfusión sobre la saturación regional de oxígeno cerebral (SrO2) en pacientes tratados mediante cirugía cardiaca con EuroSCORE I aditivo > 6. Material y métodos: Estudio prospectivo observacional. Se incluyó en el estudio a los pacientes con EuroSCORE I aditivo > 6 tratados mediante cirugía cardiaca con circulación extracorpórea. Se recogieron los valores demográficos, complicaciones perioperatorias, estancias hospitalarias, así como el valor de SrO2 basal preinducción, el valor más bajo de hemoglobina (Hb) registrado durante la cirugía, el valor de la Hb y la SrO2 pre y postransfusional, así como la existencia de una caída significativa de más del 20% del valor basal de la SrO2 o por debajo del 50%. Consideramos como respondedores a la transfusión aquellos que presentaron un aumento de la SrO2 postransfusión de al menos el 20% del valor previo, un aumento de la desviación estándar (DE) (7,9) o un aumento hasta el nivel basal. Resultados: Se recogieron los datos de 57 pacientes. El EuroSCORE I aditivo medio +/- DE fue de 7,4 +/- DE 2,6 y el EuroSCORE II fue de 6,1 +/- DE 7,4. El 52% fueron varones. Se trasfundió al menos un concentrado de hematíes al 35,1% de la muestra (20 pacientes). La SrO2 pretransfusional fue 59 +/- DE 8,6 y aumentó de forma no significativa tras la transfusión del primer CH (61,19 +/- 7,9; p = 0,1). Un 29,8% de los pacientes presentaron durante la cirugía una disminución de la SrO2 del 20% con respecto a su basal o un valor inferior al 50%. Los pacientes con una disminución significativa de la SrO2 presentaron un mayor tasa de complicaciones perioperatorias (p = 0,04). La estancia en la Unidad de Cuidados Intensivos (UCI) fue mayor en los pacientes con una disminución significativa de la SrO2 respecto a los que la no presentaron (6,8 +/- 8,2 días vs. 4,3 +/- 3,6; p = 0,01) al igual que la estancia hospitalaria (14,2 +/- 9,4 días vs. 10,1 +/- 3,1; p = 0,01). En nuestra muestra, 6 de los 21 pacientes fueron respondedores. No hubo diferencias significativas en la morbilidad o la mortalidad entre los respondedores y los no respondedores. Discusión: En nuestra población, se observó un aumento no significativo en la SrO2 tras la transfusión. Cuando se analizaron los respondedores a la transfusión por incrementos de SrO2, pocos pacientes fueron identificados como respondedores. En conclusión, la SrO2 podría no ser una herramienta que guíe la transfusión en pacientes tratados mediante cirugía cardiaca con EuroSCORE I aditivo > 6
Introduction: Cardiac surgery (CS) is associated with a significant use of blood products. The aim of this study was to evaluate the effect of red blood cells concentrates (RBC) transfusion on regional cerebral oxygen saturation (SrO2) in patients undergoing CS with additive EuroSCORE I > 6. Material and methods: This is a prospective descriptive study. Patients with additive EuroSCORE I > 6 undergoing CS with extracorporeal circulation were included in the study. The demographic values, perioperative complications, hospital/ICU length of stay (LOS), as well as the preinduction baseline SrO2values, the lowest SrO2 value during surgery, number of blood products transfused, hemoglobine (HB) and pre and postransfusional SrO2 values were recorded, and events of significant decrease in SrO2 below 20% of basal value or decrease below 50%. We considered responders those who had an increase post-transfusion SrO2 at least 20% of pre-transfusion value, an increase of standar deviation (7.9) or an increase up to basal SrO2. Results: Data from 57 patients were collected. The average additive EuroSCORE I was 7.4 (SD 2.6) and the EuroSCORE II was 6.1 (SD 7.4). 52% were male. 35.1% of patients received intraoperative transfusion of at least one unit of RBC. The overall mortality was 8.7% (N = 5). During surgery 29.8% of the overall sample presented a decrease of more than 20% of baseline SrO2 or a value lower than 50%. Patients with a significant decrease in SrO2 presented a higher rate of perioperative complications (P=0.04) and longer ICU-LOS 4.3 (SD 3.6) vs. 6.8 (SD 8.2) days (P=0.01) and hospital LOS 10.1 (SD 3.1) vs. 14.2 (SD 9.4) days (P=0.01). Pretransfusional HB was 7.4 (SD 0.8) mg/dl and postransfusional value was 8.4 (SD 0.8) (P =0.00). Pretransfusional SrO2 was 59 (SD 8.6) and increased non- significantly after RBC transfusion to 61.1 (SD 7.9) (P=0.1). Only 6 patients out of 21 could be considered responders. There were no significant differences in morbidity, mortality or LOS between responders and non-responders. Discussion: In our population a non statistically significant increase in SrO2 was observed after RBC transfusion. When considering responders few patients were identified by SrO2. In conclusion SrO2 might not be reliable triger to decide transfusion
Subject(s)
Humans , Male , Female , Aged , Oximetry/methods , Erythrocyte Transfusion/methods , Cardiac Surgical Procedures/methods , Oxygen/metabolism , Prospective Studies , Postoperative Complications/epidemiology , Blood Loss, Surgical/statistics & numerical data , Critical Care/methods , Monitoring, Intraoperative/methodsABSTRACT
INTRODUCTION: Cardiac surgery (CS) is associated with a significant use of blood products. The aim of this study was to evaluate the effect of red blood cells concentrates (RBC) transfusion on regional cerebral oxygen saturation (SrO2) in patients undergoing CS with additive EuroSCORE I > 6. MATERIAL AND METHODS: This is a prospective descriptive study. Patients with additive EuroSCORE I > 6 undergoing CS with extracorporeal circulation were included in the study. The demographic values, perioperative complications, hospital/ICU length of stay (LOS), as well as the preinduction baseline SrO2values, the lowest SrO2 value during surgery, number of blood products transfused, hemoglobine (HB) and pre and postransfusional SrO2 values were recorded, and events of significant decrease in SrO2 below 20% of basal value or decrease below 50%. We considered responders those who had an increase post-transfusion SrO2 at least 20% of pre-transfusion value, an increase of standar deviation (7.9) or an increase up to basal SrO2. RESULTS: Data from 57 patients were collected. The average additive EuroSCORE I was 7.4 (SD 2.6) and the EuroSCORE II was 6.1 (SD 7.4). 52% were male. 35.1% of patients received intraoperative transfusion of at least one unit of RBC. The overall mortality was 8.7% (N = 5). During surgery 29.8% of the overall sample presented a decrease of more than 20% of baseline SrO2 or a value lower than 50%. Patients with a significant decrease in SrO2 presented a higher rate of perioperative complications (P=0.04) and longer ICU-LOS 4.3 (SD 3.6) vs. 6.8 (SD 8.2) days (P=0.01) and hospital LOS 10.1 (SD 3.1) vs. 14.2 (SD 9.4) days (P=0.01). Pretransfusional HB was 7.4 (SD 0.8) mg/dl and postransfusional value was 8.4 (SD 0.8) (P =0.00). Pretransfusional SrO2 was 59 (SD 8.6) and increased non- significantly after RBC transfusion to 61.1 (SD 7.9) (P=0.1). Only 6 patients out of 21 could be considered responders. There were no significant differences in morbidity, mortality or LOS between responders and non-responders. DISCUSSION: In our population a non statistically significant increase in SrO2 was observed after RBC transfusion. When considering responders few patients were identified by SrO2. In conclusion SrO2 might not be reliable triger to decide transfusion.
Subject(s)
Brain/metabolism , Cardiac Surgical Procedures , Erythrocyte Transfusion/methods , Oxygen Consumption , Aged , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Erythrocyte Transfusion/statistics & numerical data , Extracorporeal Circulation , Female , Hemoglobin A/analysis , Humans , Intraoperative Complications , Length of Stay , Linear Models , Male , Postoperative Complications , Prospective Studies , Spectroscopy, Near-InfraredABSTRACT
Introducción. El objetivo de este estudio es describir nuestra experiencia en la cirugía de revascularización coronaria aislada en pacientes mayores de 80 años e identificar los riesgos específicos y predictores de mortalidad precoz. Material y métodos. Entre enero de 1999 y junio de 2013, 3.097 pacientes fueron sometidos a cirugía de revascularización coronaria aislada. Se analizaron los pacientes mayores de 80 años de edad. Se realizó una regresión mutivariante de Cox para predictores de mortalidad. Resultados. Se identificaron 99 pacientes mayores de 80 años (grupo-80; edad media 82±3,5 años) y 2.957 menores de 80 años (grupo control; edad media 64,2±9,7 años). El EuroSCORE aditivo fue 8,4±4,8 y 4,6±4,6 (p<0,001) en los>80 años vs.<80 años, respectivamente. La cirugía sin CEC se realizó en el 79,6% en el grupo-80 años. La mortalidad a los 30 días en el grupo-80 fue significativamente superior, del 11,2 vs. 3,3% (p<0,001). El grupo-80 se reintervino por sangrado más frecuentemente (9,2 vs. 2,9%; p=0,001) y tuvieron con mayor frecuencia complicaciones cardiovasculares mayores (6,1 vs. 2,1%; p=0,001). Los predictores independientes de mortalidad a 30 días fueron: la reintervención por sangrado (HR 5,7; IC 95% 1,6-19,5) y las complicaciones cardiovasculares mayores (HR 3,7; IC 95% 1,1-12,2). El seguimiento medio del grupo-80 fue de 6,3±4,2 años, con una supervivencia acumulada de estos pacientes del 65,7% durante el periodo de estudio. Conclusión. La cirugía de revascularización coronaria aislada se realiza preferentemente en pacientes mayores de 80 años sin CEC. Presentan una mayor incidencia de complicaciones cardiovasculares, reintervenciones por sangrado en el postoperatorio inmediato y una mortalidad más elevada (AU)
Introduction. We aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup. Material and method. From January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed. Results. We identified 99 patients older than 80 years (80-group; mean age 82±3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2±9.7 years). Additive EuroSCORE was 8.4±4.8 and 4.6±4.6 (P<.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (P<.001) in the 80-group vs. the control group. respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (P<.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; P=.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; P=.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6-19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1-12.2). The mean follow-up was 6.3±4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period. Conclusion. Coronary artery bypass graft is performed preferably in patients over 80 years old under the off-pump procedure. Mortality is higher in this group of patients probably related to a higher incidence of cardiovascular complications and reintervention for bleeding in the immediate postoperative period (AU)
Subject(s)
Humans , Male , Female , Aged, 80 and over , Myocardial Revascularization/methods , Percutaneous Coronary Intervention/methods , Coronary Disease/mortality , Coronary Disease/surgery , Survivorship/physiology , Anesthesia , Multivariate Analysis , Retrospective Studies , Kaplan-Meier EstimateABSTRACT
INTRODUCTION: We aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup. MATERIAL AND METHOD: From January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed. RESULTS: We identified 99 patients older than 80 years (80-group; mean age 82±3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2±9.7 years). Additive EuroSCORE was 8.4±4.8 and 4.6±4.6 (P<.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (P<.001) in the 80-group vs. the control group. respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (P<.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; P=.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; P=.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6-19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1-12.2). The mean follow-up was 6.3±4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period. CONCLUSION: Coronary artery bypass graft is performed preferably in patients over 80 years old under the off-pump procedure. Mortality is higher in this group of patients probably related to a higher incidence of cardiovascular complications and reintervention for bleeding in the immediate postoperative period.
Subject(s)
Coronary Artery Bypass/mortality , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment , Survival Rate , Time FactorsABSTRACT
A 41-year-old woman with end-stage renal insufficiency in peritoneal dialysis for 3 years received a kidney transplant under anesthesia with remifentanil, propofol, and cisatracurium. She had a history of hypertension and was being treated with enalapril, metoprolol and erythropoietin. After anesthetic induction, blood pressure fell significantly and surgery was performed in a context of hemodynamic stability. The postoperative course was good, with a functional graft and adequate diuresis from the start. Anesthetics with minimal residual effects and as little renal toxicity as possible are ideal for use in kidney transplantation. The drugs used in this case had pharmacokinetic and pharmacodynamic properties that make them particularly appropriate for such patients.
Subject(s)
Anesthesia, Intravenous , Anesthetics, Intravenous/administration & dosage , Atracurium/analogs & derivatives , Atracurium/administration & dosage , Kidney Transplantation , Neuromuscular Blocking Agents/administration & dosage , Piperidines/administration & dosage , Propofol/administration & dosage , Adult , Anesthetics, Intravenous/pharmacokinetics , Atracurium/pharmacokinetics , Female , Humans , Hypertension/complications , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/metabolism , Kidney Failure, Chronic/surgery , Neuromuscular Blocking Agents/pharmacokinetics , Piperidines/pharmacokinetics , Polycystic Kidney, Autosomal Dominant/complications , Polycystic Kidney, Autosomal Dominant/surgery , Propofol/pharmacokinetics , Remifentanil , Renal Circulation/drug effectsABSTRACT
Una paciente de 41 años de edad con insuficiencia renal terminal, en diálisis peritoneal desde hacía tres años, fue sometida a un trasplante renal mediante técnica anestésica que utilizó la asociación de remifentanilo, propofol y cisatracurio. Tenía antecedentes personales de hipertensión arterial y seguía tratamiento con enalapril, metoprolol y eritropoyetina. Tras la inducción anestésica se observó una disminución importante de la tensión arterial; el resto de la intervención cursó con estabilidad hemodinámica. La paciente evolucionó favorablemente con injerto funcionante y diuresis adecuadas desde el inicio.La técnica anestésica ideal para trasplante renal debería utilizar fármacos con mínimos efectos residuales y la menor toxicidad renal posible. Los fármacos utilizados en este caso presentan características farmacocinéticas y farmacodinámicas que los hace especialmente apropiados para estos pacientes (AU)
Subject(s)
Adult , Female , Humans , Kidney Transplantation , Anesthesia, Intravenous , Propofol , Polycystic Kidney, Autosomal Dominant , Anesthetics, Intravenous , Neuromuscular Blocking Agents , Piperidines , Renal Circulation , Atracurium , Hypertension , Renal Insufficiency, ChronicABSTRACT
En la atención farmacéutica la práctica clínica amplía su perspectiva asistencial hacia la identificación y resolución de problemas terapéuticos y la prevención de los mismos. El objetivo del presente trabajo es evaluar un Programa de Atención Farmacéutica instaurado en las unidades de hospitalización con dispensación individualizada de medicamentos en dosis unitarias (168 camas), del Hospital de Rehabilitación, perteneciente al complejo hospitalario del Hospital Universitario La Fe de Valencia. La evaluación se realizó del período de 13 meses de instauración de dicho programa. La prevalencia de pacientes con problemas terapéuticos fue de 2,1 por ciento (n=78) con un total de 85 participaciones, ya que el 91,8 y el 8,2 por ciento de los pacientes presentaron uno y dos problemas, respectivamente. Las recomendaciones, dirigidas mayoritariamente al médico para la suspensión de tratamientos por ser considerados éstos prolongados o duplicados, fueron aceptadas en el 62,4 por ciento (n=53). La idoneidad clínica de las actuaciones, resultó ser importante sin mejora para el cuidado del paciente en el 56,5 por ciento (n=48) y con mejora del cuidado del paciente en el 37,6 por ciento (n=32). La aplicación del Programa de Atención Farmacéutica se ha mostrado como una herramienta útil para detectar, resolver y prevenir problemas relacionados con la medicación, a partir de la historia farmacoterapéutica, permitiendo calcular una serie de indicadores que deben servir como base para el desarrollo de futuros planes de mejora continuada de calidad. (AU)
